Meet Dr. Freud

Does psychoanalysis have a future in an authoritarian state?

Video consultations are popular, but some question whether China should bother with a therapy that the West has largely discarded.

Illustration by ANDRÉ CARRILHO

Elise Snyder fell in love with the world of Sigmund Freud at a public library in the Bronx when she was fourteen. At sixteen, she went into analysis, against her parents’ wishes, paying for it with money that she earned babysitting. An hour of excavating the unconscious to her was like a string quartet, in which, as she put it recently, “one could hear all four instruments and all four melodies and how they fit together.”

Snyder, who was born in 1934, grew up as a latchkey kid, and she enjoyed the independence. During school lunch hours, she walked home to eat and listen to soap operas on the radio: “Our Gal Sunday,” “The Romance of Helen Trent_.”_ Her father, Harry Wechsler, had been a promising lawyer until he lost a race for a judgeship in 1933 and was left unemployed and depressed. Her mother, Dora, a bookkeeper, was barely five feet tall, with a regal voice that reminded people of Eleanor Roosevelt’s. Dora had always expected more out of life and had “no talent for happiness,” her daughter thought.

Shortly after Elise discovered Freud, she contracted bulbospinal polio, which interfered with her breathing and paralyzed her left leg. Doctors advised her parents to send her to Warm Springs, Georgia, to recover, but Snyder refused, in the belief that “if I didn’t keep moving very quickly I would cave in.” She recovered, and graduated from high school at sixteen. (She had turned down Bronx Science because it did not require Latin.) She went to Queens College, and then to medical school at Columbia, where she earned money editing a manuscript by the anthropologist Géza Róheim about a trip to Australia—sponsored by the psychoanalyst Princess Marie Bonaparte—to determine if Aborigines had an Oedipus complex. (Róheim concluded that they did.) Judith Schachter, who was a medical resident a few years ahead of Snyder, recalls, “She was extremely beautiful” and “very, very, very smart,” adding, “And I know the difference between smart and very, very, very smart.” In her fourth year, Elise married a young professor of medicine named Arthur Snyder. She graduated in 1958, and received two presents: a sewing machine and the collected works of Sigmund Freud.

She entered psychiatry at a time when the field was heavily influenced by psychoanalysis. It was surging in popularity amid postwar opposition to totalitarianism and dissatisfaction with the overuse of organic treatments such as shock therapy and frontal lobotomies. Between 1940 and 1960, according to the historian Eli Zaretsky, the American Psychoanalytic Association expanded more than fivefold. A story on the cover of Newsweek in October, 1955, titled “The Mind: Science’s Search for a Guide to Sanity,” estimated that one in every seventeen Americans needed psychiatric care. That year, the president of the American Psychoanalytic Association, Ives Hendrick, told members that success had given analysis “unsought and unexpected powers.”

Snyder built a busy practice in Manhattan that eventually included two forms of treatment: initially, she conducted psychoanalytic psychotherapy, in which patients came one, two, or three days a week and sat upright; later, she began conducting full Freudian analysis, in which patients visited four or five days a week and lay on the couch. When she was thirty, shortly after the birth of her second child, Snyder had a disturbing nightmare and arranged to visit one of her former analysts, Victor Rosen, a well-known figure who had been elected president of the American Psychoanalytic Association. Snyder later recalled of the visit, “I realize he’s not listening to me, and suddenly he jumps up and says, ‘I’m in love with you. I’ve been in love with you for the past two years.’ ” Romance with a patient, current or former, was taboo in analysis. But Snyder was unhappy in her marriage and was flattered by Rosen’s interest. “What a narcissistic gratification this is: here’s the person you talk to about your toilet training, and he says he’s in love with you,” she said.

They left their spouses and married in 1965. Because of Rosen’s position, it was a full-blown scandal. Heinz Kohut, one of the patriarchs of analysis, warned that it “could weaken the position of our science.” It was the most notorious affair since Elaine May, the comedienne, had married her analyst, David Rubinfine, in 1963. (For a while, the two couples, estranged from peers, socialized with each other.) Roger Goettsche, an analyst in Clinton, Connecticut, said of Snyder, “She was both an insider—she married her analyst, who was president of the American Psychoanalytic; how much more insider can you be?—but an outsider, too, in that there was this taboo that had been somehow broken.” Rosen left a prestigious post at the New York Psychoanalytic Institute, and the couple moved to Connecticut. Snyder discovered that her new husband was addicted to Demerol. He quit, then relapsed, and the addiction worsened. He had become suicidal. After seven years of marriage, she told him that she was leaving. He went missing the next day. Police found him in his car in the woods, dead from an overdose of Demerol and barbiturates.

Snyder was suddenly a widow with two children living in an old house in Connecticut. “I would get so lonely that I would drive around to the gas station and get a dollar’s worth of gas just to chat,” she said. Professionally, her reputation had suffered. Goettsche said, “For some, there was always this sense that she crossed a line, so I don’t think she was always treated with the regard that I think she should have been.” A veteran New York analyst told me recently that Rosen became a symbol of the perils of getting involved with a patient: “People would say, ‘Remember Victor Rosen.’ ” Other psychoanalysts responded, Snyder said, “as though I were the scarlet woman who had seduced their beloved Victor.” She added, “That I have stayed so committed to analysis is truly amazing.”

Psychoanalysis, however, was falling out of step with the times. Bruno Bettelheim declared that antiwar demonstrators were simply acting out an Oedipal conflict. Hollywood, which had lionized analysts in the fifties, began depicting them as corrupt or pathetic. In Woody Allen’s “Manhattan” (1979), Diane Keaton’s analyst phones her at night to sob. Gloria Steinem wrote that Freud had inspired “modern psychiatry’s refreshing ability to ignore poverty, deprivation, power systems of sex, race or class.” Patients had new options: Miltown, America’s first minor tranquillizer, had cleared the way for a spate of new drugs, and cognitive behavioral therapy, or C.B.T., promised an average duration of just sixteen sessions, instead of years of awkward silences. Insurance companies and managed-care organizations favored the newer, less expensive approaches, and when they pushed psychoanalysis to produce empirical measurements of its effectiveness the profession was slow to respond.

By 1997, nine million Americans were in therapy, but fewer than a million were in the long-term frequent treatment that Freud ordained. In 2010, one-third of the members of the American Psychoanalytic Association were over seventy years old, and its president, Dr. Warren Procci, said in the group’s newsletter, “There is an unavoidable message here, much as we do not want to hear it. . . . We are in a decline.”

But Snyder, who is now an associate clinical professor of psychiatry at Yale, never lost faith. She returned to a prominent role in the psychoanalytic community, in part through her dogged efforts to promote it. To rally the membership, she once printed hundreds of T-shirts bearing Freud’s portrait for analysts to wear during a road race in San Francisco. She held various offices in the association and, in years of debate over issues such as the requirements for membership and the selection of training analysts, she was a vocal, and polarizing, advocate for relying on a board that is elected, rather than appointed. On occasion, she compared her opponents to the Committee of Public Safety under Robespierre—or, worse, to a New York co-op board. “She just has that quality: people get agitated by her,” Schachter, a friend who is the treasurer of the American Psychoanalytic Association, said.

In 1999, Snyder ran for the presidency of the association and lost. In 2001, she attended a literature conference in Beijing. She had been to China once before, as a tourist, but this time she sent e-mails around before she left to find out if the Chinese were studying analysis. She was referred to a group of professors, students, and others in the western city of Chengdu, who were studying psychoanalysis as a theory, not as a clinical practice. Freud was translated into Chinese as early as the nineteen-twenties; one scholar, Gao Juefu, had wondered if psychoanalysis might combat Chinese superstitions, though he found some of the sexual theories “preposterous.”

Over the years, modernist writers such as Shen Congwen, Lu Xun, and Qian Zhongshu drew on Freud to express ideas about individuality, but his following was limited. In the eighties, before the crackdown at Tiananmen Square, an interest in psychoanalysis became a symbol of openness for a generation of élite college students, a fad known as Freud Fever. In some cases, their enthusiasm outpaced their information: Huo Datong, one of China’s earliest aspiring analysts, moved to Paris in 1986 to study with his idol, Jacques Lacan, who, he soon found out, had been dead for five years.

When Snyder arrived in Chengdu, she discovered that students were eager to be analyzed but had trouble finding anyone to do it. They later suggested Skype, the video-chat software, which Snyder had never heard of. After she returned home, she recruited a few American analysts to start conducting analysis over the Web. She began flying to China regularly, and found that word had spread among leading psychiatry and psychology departments. “I had become, in a minor way, sort of famous in China,” she said.

I started coming to China fifteen years ago, and, until recently, I had never heard anyone mention a therapist. The concept of discussing private troubles and emotions with a stranger runs counter to some powerful Chinese beliefs about the virtues of “eating bitterness” and the perils of “disasters that come from the mouth.” For most of Chinese history, mental illness carried a stigma of weakness so intense that the siblings of a disturbed person could have trouble finding a spouse. Mental health was left largely to herbalists, who tried to rebalance the seven emotions—happiness, anger, sadness, fear, love, hatred, and desire—and to witch doctors, who sought to calm the unhappy spirits of ancestors or encourage patients to adjust to life’s setbacks. At the time of the Communist revolution, in 1949, China had some sixty psychiatrists for a population of nearly five hundred million.

Life under Chairman Mao was even less congenial to soul-searching. When the Great Leap Forward, launched in 1958, resulted in a famine that killed between thirty and forty-five million people, the Party barred any studies of its psychological impact on the population. That was true as well for the Cultural Revolution, which began in 1966 and unfolded on a scale of barbarity that the Chinese do not often discuss in detail. In Zhejiang Province, more than nine thousand people were officially “hounded to death”; children denounced their parents, and political targets were paraded in stadiums packed with screaming crowds; students at a Beijing girls’ school beat their vice-principal to death with nail-studded planks; in 1968, in at least two provinces, political zealots ate their victims. Ten years later, when Deng Xiaoping took control of the country, the government pursued only the most notorious killers and torturers. A more exhaustive accounting, or process of reconciliation, might have threatened the Party and delayed an economic recovery, and Deng issued a final resolution in the hope that “debate on the major historical questions will come to an end.” (An early draft was revised, because Deng found it “too depressing.”) People returned to their factories and offices, often alongside their tormenters and victims. Ordinary Chinese were willing to aid in the forgetting, not only because they were poor and determined to get on with their lives but because so many had been victims at some moments and perpetrators at others.

Before long, economic rebirth was transforming China with unprecedented wealth but also with radical change: history’s largest human migration sent a hundred and thirty million citizens to cities in search of jobs, and left almost sixty million growing up apart from one or both parents. An affluent new class emerged, creating a gap between the rich and the poor that is approaching the size of America’s. Hundreds of local colleges opened across the country, luring students and draining their families’ savings, and churning out more graduates than the economy could absorb, fuelling an atmosphere of brutal competition.

In recent months, there have been signs that the pressure is greater than anyone imagined. Last January, a nineteen-year-old named Ma Xiangqian jumped from the roof of his factory dorm at Foxconn Technology, where he had worked seven nights a week, eleven hours at a stretch, making electronic parts, before being demoted to cleaning toilets. In the months after Ma’s death, ten other workers committed suicide at Foxconn factories, which make iPhones and other products. Articles in the Chinese press asked whether suicide was spreading at Foxconn like a virus or if the cluster of suicides was any larger than the usual rate for a factory as big as a city. Foxconn boosted wages and installed nets around the roofs of its buildings. The suicides diminished as abruptly as they had begun.

In the West, the iPhone suicides, as they were known, sounded like a classic sweatshop case, but in China mental-health experts traced the deaths to deeper roots. Foxconn wasn’t “any different from any of the other big companies who are doing the same thing,” Michael Phillips, a Canadian who heads the suicide research and prevention department at the Shanghai Mental Health Center, told me. Beyond the drudgery of the assembly line, workers in their teens, or barely out of them, were struggling to live far from home, save money, meet spouses, and educate themselves in their time off, all under the eye of a state with no organized outlet for complaint. If the suicides revealed cracks in the world of migrant labor, another macabre phenomenon exposed the stresses mounting in one more demographic: in a series of murderous attacks over the summer, middle-aged men in financial or psychological trouble set upon young children in their classrooms or near the schools. The killers all had grievances against landlords, neighbors, or others. China has strict gun controls, so the attackers used cleavers and hammers, and the killings terrified a public that, because of the one-child policy, is uniquely sensitive to school violence.

The iPhone suicides and the kindergarten killings focussed attention on a startling fact, published last year in the British journal The Lancet: nearly one in five adults in China has a mental disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders, a figure that put China in the ranks of the most mentally ill countries in the world. Scientists debated whether the estimate was too high, but other figures are beyond dispute: Suicide is the leading cause of death among young people. Only one in twenty Chinese people with a mental disorder has ever seen a professional about it.

Big cities in China have mental hospitals, but they are still building up the range and capacity to deal with the widespread problems of day-to-day life. In 2005, the head of a Beijing suicide hot line told me that the service was so understaffed that the average caller needed to hang up and redial about eight times in order to get past the busy signal. (Later, the hot line added staff; today, the average caller dials twice to get through.)

These days, the Chinese are increasingly willing to pay to talk. Arthur Kleinman, a Harvard psychiatrist and China specialist, said, “This is radically distinctive from the past.” As he sees it, a mental shift has occurred, in “the very words used to talk about the self, which were always available to people if they wanted them, but were regarded as selfish and egocentric.” The Chinese call it the “psycho boom.”

A few years ago, Chinese television launched a program called “Xinli Fangtan”—“Psychology Sessions”—in which people sit at a heart-shaped table and talk with a therapist about their troubles. It provides a running tally of the side effects of the national growth spurt: bankruptcy, extramarital affairs, gambling, health-care costs, unemployment, loneliness. Unlike Americans, who can look comfortable divulging details of their private lives on Dr. Phil’s stage set, the guests on “Psychology Sessions” favor earnest, if hasty, disguises. One woman told her story from behind a large pot of bamboo. A couple and their young son wore oversized baseball caps and sunglasses, which made them look like a blind family at a ballgame. The titles of the episodes are crafted to drop a scrim of propriety over the indignities of modern life: a dysfunctional rich family tells its story in “Millions of Wealth, Millions of Hatreds”; the sad tale of an affair is titled “An Encounter with My Husband’s Close Female Friend.”

Beyond giving people the chance to talk, psychotherapy has always offered the seductive promise of transforming the ways that men and women see themselves and their relationship to authority. In 1935, after Hitler took control of Germany, a Polish Jewish psychoanalyst named Gustav Bychowski, who had been a student of Freud’s, visited Freud in Vienna and asked what the discipline could do to counter the rising threat. Freud, who was driven into exile three years later, said he hoped that psychoanalysis would lead to a day in which “these horrifying reactions of the collective psyche would no longer be possible,” as Bychowski put it.

Bychowski was my great-uncle. He returned to Poland, where he practiced psychoanalysis until the arrival of the war; his son, Jan Ryszard, died as a navigator in the Polish squadron of Britain’s Royal Air Force. Uncle Gustav later settled in America; he became a training analyst at the New York Psychoanalytic Institute, published widely, and kept a bust of Freud in the front hall of the family’s apartment, on Fifth Avenue. He was a vibrant figure—he was touring Morocco with his wife when he died, at the age of seventy-seven—but he never let go of the question that he had posed to Freud. In 1948, Gustav published a psychoanalytic history—“Dictators and Disciples: From Caesar to Stalin”—dedicated to the memory of his son. “Anyone who loves liberty is bound to ponder deeply over the origin and causes of this evil and the possibilities of preventing and curing it,” he wrote.

In Beijing last fall, I met Elise Snyder in the lobby of the People’s Palace, a Stalinist hulk of a hotel on the west side of the capital. At seventy-six, she has the flowing gray hair and cheery vigor of a cyclist in a Centrum Silver commercial. She was dressed in a black-and-white herringbone cape, over a purple sweater and matching scarf. She had arrived from New York the night before, but her large blue-gray eyes showed no sign of fatigue. On the contrary, she lives in constant search of channels for her energy. A few years ago, she got into live birds and filled her home with more than two hundred caged canaries and finches. “My husband said finally, ‘It’s me or the finches,’ ” she recalled.

Her husband, Michael Holquist, a professor emeritus of comparative and Slavic literature at Yale, had accompanied her to China. “I feel like the preacher’s wife,” he said. They had met at Yale in 1986, after the end of her third marriage (art historian, seven years). “She was the wise woman in my life through a number of peccadilloes, and we often got together to talk about ideas,” Holquist, who has white hair and a matching beard, said. Friends were surprised when they began dating. “They thought of us as friends who often publicly disagreed on a number of things,” he said. They married in 1999. Snyder has two daughters: Margaret, a psychoanalyst who lives in New York, and Katherine, an associate professor of English at Berkeley. Holquist has five grown children.

Snyder and Holquist were in Beijing for Freud and Asia, the first conference organized by the International Psychoanalytic Association on the continent. Giant pictures of Freud were as ubiquitous in the People’s Palace, where it was held, as Mao’s face is in and around Tiananmen Square. In the years since the first analyses via Skype, Snyder had created a non-profit organization called the China-American Psychoanalytic Alliance, or CAPA, which she runs from the dining-room table of her apartment on the Lower East Side. Her staff consists of an administrative director, an intern, and half a dozen part-time volunteers. By this winter, the list of Chinese patients in Skype analysis had grown to forty-one; forty more were in a less intensive treatment—psychodynamic psychotherapy. For patients, Skype means getting used to the pixellated face of their therapist. “I have to tell her I’m crying, because she can’t see my tears,” Chen Yuying, a fifty-year-old mother in Shanghai, said of her analyst, who’s on the Upper East Side. Chen hopes that “someday I can fly to New York and lie on the couch and have the real experience,” but, until then, “it’s wonderful.” She went on, “There has never been a person so unconditionally accepting of me.” Skype has become so routine among Chinese patients that Shmuel Erlich, an Israeli analyst, says he met a woman in Beijing who “was astonished that there was some other kind of analysis.”

Two years ago, Snyder started a Web-based training program in psychotherapy that has students in twelve Chinese cities. The first thirty graduated last fall; a hundred more are in the pipeline. Tuition is sixteen hundred dollars for thirty weeks of classes and yearlong case supervision. (The cost of analysis is extra, adjusted to what the patient can afford—between five and forty dollars an hour. Some Americans do it pro bono.) Snyder also operates an intellectual boatlift of sorts, adopting the libraries of retiring analyst friends in order to send thousands of psychoanalytic books to China. “Everybody is moving into smaller apartments,” she said, and the Chinese can’t seem to get enough of the books. “They’re in love with psychoanalysis the way people my age were in love with it in New York in the fifties and sixties.”

As we crossed the hotel lobby on the way to the opening ceremony, a Chinese student approached us and threw her arms around Snyder. In contrast to analysts who lead what Snyder calls “hermetically sealed lives,” she prefers to “touch people when I talk to them—lots of hugs and kisses.” We reached the lecture hall, a scene of tented fingers and Mephisto walking shoes. The crowd numbered about five hundred, from China and abroad, and it bore an obvious pattern: the Westerners were old and the Chinese were young. That was fine with the I.P.A., which had made a point of coming to Asia on its hundredth anniversary, to signal, as Charles Hanly, the president, put it in his opening speech, “a historic turning point.”

“We are fortunate to be able to pass on to future generations the great inheritance that we have received,” Hanly said. The Chinese were happy to play their part. “If we could say that the I.P.A. is a wise and learned centenarian,” a Chinese official declared during another session, then China’s mental-health system is “a young adult in the prime of life.”

“It’s like a bar mitzvah,” Snyder murmured, seated in the audience. The conference program was classic psychoanalytic fare with an Asian twist. A discussion of “A Psychoanalytic Interpretation of Dieyi Cheng in the Film ‘Farewell My Concubine’ ” was followed, a day later, by a panel on “Use of Images in Chinese Ancestor Worship.” Some topics looked like perennials: had the I.P.A. really never discussed “Psychodynamic Mechanisms of Frigidity in Women”?

The opening session included nineteen speeches. “We keep our mouths shut all day long, so we get here and blah, blah, blah,” Snyder whispered. When I invented a reason to step out for some air, she requested in mock desperation, “Bring sandwiches.”

American psychoanalytic institutes often have trouble finding willing patients; Chinese programs have the opposite problem. When Beijing University held a series of lectures on Carl Jung a few years ago, it could admit only a quarter of the people who wanted to attend. Even so, China and Freud are still getting acquainted. In Beijing, I watched a visiting analyst address his audience with a joke—“What is a psychoanalyst? A Jewish doctor who can’t stand the sight of blood”—which his Chinese listeners greeted with respectful silence. The deeper divide, however, may be more subtle, between a theory that Freud hoped would “disturb the world” and a Chinese philosophical tradition that values harmony and accommodation as the route to fulfillment. Will a Chinese patient be more comforted by a therapy that advocates autonomy and independence—or by one that promotes accommodation to the constraints of a system?

China has already imported other Western therapeutic models, including systematic family therapy, C.B.T., and sandplay (the practice of using a sandbox and miniature figures to express oneself), and China has been granting credentials in counselling since 2003. (The license is not widely respected; it is granted by the Ministry of Labor and Social Security, rather than by the Ministry of Health, and it requires no clinical experience.) Psychoanalysis, for all its troubles in America, benefits from brand recognition among China’s cachet-conscious middle class. “When they want to buy a new bag, they buy a Gucci,” Kleinman told me. Likewise, he added, “Psychiatrists in the élite institutions have come to associate psychotherapy with psychoanalysis”—with Freud. In addition to Snyder’s program, German analysts have been teaching psychotherapy in various forms for more than a decade, and so has, more recently, a Norwegian group. In 2008, the I.P.A. began teaching full-fledged analysis to the first round of Chinese candidates. A project is under way to retranslate Freud, directly from the German. Some earlier translations were secondhand, having begun in German and passed through English and Japanese before landing in Chinese. Others took liberties. To appeal to readers, one edition of Freud’s autobiography depicted him rattling off classical Chinese allusions with the fluency of a Confucian scholar and bidding farewell to Austrian colleagues by cupping his hands in front of his chest.

At the conference, I attended a presentation by an aspiring Chinese analyst named Zhong Jie; afterward, he invited me to his home in Beijing, near Tiantongyuan, a cluster of pale, pointy high-rises which is famous for being the largest housing compound in China (it has four hundred thousand residents). When it was built, it was a symbol of middle-class prosperity, but recently it has become a symbol of frustration, housing more people than the local hospital and school can handle.

Zhong Jie lives nearby in a smaller, well-tended complex. He is an assistant psychology professor at Peking University, and he is one of nine Chinese candidates receiving full analytic training from the I.P.A. On the side, he provides psychoanalytic therapy, for fees ranging from thirty-five to seventy-five dollars an hour, and he was eager to show me his consultation room: a red Oriental rug, a chaise longue, an armchair. I half expected Freud to appear in the doorway wreathed in cigar smoke.

“I had it specially made,” Zhong said of the furniture. “It’s a Central European style.” Zhong is thirty-six, with a round face and tidily parted hair. He gestured for me to try the couch, placing a cream-colored napkin across the pillow. I lay down, and the room was silent. “When a patient arrives, I close the door and draw the curtains, and he can look at the plain wall,” Zhong said. “No distractions.”

I asked what problems he sees most often among his patients. He answered, “If a grandfather, for example, was criticized and abused in the social upheaval of the nineteen-sixties and seventies, then he couldn’t take care of his child, so the child was raised in a chaotic situation and had to develop defensive ways to cope.” In that way, the Cultural Revolution can produce marital or family problems that trickle down to a third generation. “From my point of view, the upheaval never ended,” he said. “It repeats within the family.”

Zhang also treats patients who during childhood were separated from their parents, because of the demands of their parents’ work. “This can create a lot of trauma for a child,” he said. After a moment, he added, “My experience was like this.” His parents, who were laborers in Sichuan Province, sent him, at age four, to be raised by grandparents. “This led to a very complicated life,” he said, with a slight smile. He recently divorced. “It’s sad, but it’s the reality.” He was spending a lot of time with his own analyst: four hundred and eighteen sessions and counting. “I told my analyst that maybe the separation explains why I work very hard on my work, and why I keep a distance in interpersonal relationships.” He laughed awkwardly. “It’s easy to understand, but it’s a little bit hard to change. That’s why I need more sessions.”

I rose to leave, and Zhong showed me out. “Hear that?” he said, referring to the squawk of a distant loudspeaker. “It’s telling people who live back there to move.” He nodded toward a group of low-slung brick houses behind his compound. A farming village next to his residence was being demolished, to make way for a high-tech development zone to be called Future Science and Technology City.

The struggle over demolition and development is a kind of national psychodrama in China, infused with emotional debate over power, progress, and fairness and fed by the competition between individual rights and collective benefits. The demolition near Zhong’s residence looked nearly complete. Hundreds of houses in every direction had been turned into mounds of brick and cement and rebar. Among the rubble, a few buildings remained—the holdouts. In cases like this, there are always people who stay as long as possible, in the hope that developers will pay them extra to relocate. It’s demolition roulette: in some cases, the holdouts prevail and get more money; in others, they end up being violently evicted. I reached the center of the demolition zone, where the loudspeaker was playing a recorded message in a loop, urging people to accept the compensation on offer and leave peacefully: “Don’t listen to rumors! The policies on demolition and relocation will never change!” The sound echoed off the homes of the holdouts. “Sign now, and enjoy a comfortable and wonderful new life with your fellow-villagers!”

After several days of Freud and Asia, Snyder turned her attention to a delegation of American analysts and their spouses, who had arrived for a two-week mental-health tour d’horizon that she organizes once a year. Although scheduling is difficult—“Between the Jewish holidays and the Chinese official calendar, there aren’t many options”—she had managed to round up twenty-six people to fly in, lecture, sightsee, and meet patients whom they had previously seen only on computer screens. The tenor of those meetings, after months or years of Skype analysis, can be difficult to predict. “It was extremely awkward—not at all like a usual session,” Ralph Fishkin, a Philadelphia-based analyst, told me, of his first encounter with a Skype patient in the flesh. But, when Fishkin returned to China a year later, their second meeting went far more smoothly, a development he credits to another year of online treatment.

“I wasn’t sure that an analysis on Skype was a very good idea, but there was this long waiting list of people, so I agreed to do it,” Nell Logan, of Chicago, told me one afternoon, as the visitors toured Beijing’s Olympic Stadium. Logan wore a royal-blue baseball cap with “FREUD” emblazoned in large letters across the front. She does Skype analysis three days a week, signing on after dinner from the computer in her guest room just as her patient is arriving at her office, following the morning commute. “The young woman that I’m seeing has made some nice changes that have shown up in her dreams,” she said.

Snyder peeled off from the group in order to visit university campuses, lecture, recruit new students for her training program, and listen to local therapists present their cases—a series of brief, often devastating glimpses of people in distress. In a classroom in Beijing one night, she heard the story of a man in his early twenties in a gritty, industrial city who is saving up for sex-change surgery; in the meantime, his father has suggested a local therapy that involves learning to box in order to become more masculine. A few days later, Snyder received a briefing on an élite graduate student who was paralyzed with the fear of failing the English exam that is required for study abroad. In some instances, younger students spoke candidly with her about their lives. In a classroom at one university, a well-dressed undergraduate raised her hand and said, “Sometimes I go a whole month where I hardly eat any food. I drink only liquids, and I have trouble sleeping.” She asked if this was a problem. Snyder looked at her and said, “This is a problem.” Then, in a ritual that I came to recognize at the end of every visit, Snyder pulled out a stack of yellow CAPA brochures and passed them around the room.

Before dinner one night, Snyder and the other foreigners held a ceremony in honor of the first class to graduate from the two-year training program in psychotherapy. She hailed the graduates as pioneers, and called them up to receive pumpkin-colored diplomas that had been printed at home. (The curriculum approximates a two-year training program offered by an American psychoanalytic institute, though Chinese students cover less material. The diplomas carry no official weight in China or America.) Many of the new graduates were already practicing psychiatrists or professors of psychology at top Chinese universities, but the study of psychoanalysis had been an emotionally intense experience, and they reacted to the homemade diplomas with giddy satisfaction. Ji Xuesong, a professor at Peking University, thrust his diploma over his head with both hands, like a hockey player hoisting the Stanley Cup. Snyder wept.

One afternoon at Freud and Asia, Snyder and some colleagues presented a pair of upbeat papers on the growth of their program and the virtues of Skype analysis. But when it was time for a formal response Sverre Varvin, a Norwegian analyst with a trim white beard and glasses, was less sanguine. “We need to be more serious,” Varvin told the presenters and the audience, “especially because what is done now in China has implications for the future.” Varvin sits on the I.P.A.’s China Committee. He was reflecting the group’s reluctance to endorse the use of Skype until it has been studied more thoroughly. Varvin ticked off technical concerns, such as dropped calls, adding that Skype deprives analysts of the “bodily presence”—the “nonverbal channels of communication,” such as a patient’s bearing upon entering the room. He added an acknowledgment of the tension emerging in China’s analytic community, between Snyder’s group and the I.P.A.—“a kind of politicization of the relationship,” as he put it.

Snyder’s face hardened. She compared the debate to the endless discussion over the number of days a week that qualifies as psychoanalysis. “Skype is certainly imperfect,” she said. “But Skype is there.” She had heard, she added, that some leaders of the I.P.A. “have not wanted to have us here.”

Varvin looked flustered and called it “a very strange fantasy” to suggest that the I.P.A. had tried to exclude Snyder’s group. At last, a Chinese therapist named Fang Li raised his hand and said, “It is supposed to be a conference on analysis in China, but it seems to be a debate between only Westerners.”

Indeed, the starring role of foreigners in the growth of psychoanalysis in China has created another source of opposition. José Saporta, a clinical instructor in psychiatry at Harvard Medical School, taught in Snyder’s program until last spring, but now he warns of the “dangers of psychoanalytic evangelism.” Psychoanalysts face a “tremendous seductive power” in teaching in China, he said, because “people latch on to your every word and they treat you like a rock star, when, in the United States, nobody cares!” Saporta told me that he thinks psychotherapy should grow in China, but more slowly.

Saporta worries that differences in language and world view could alter the way therapy affects patients in China. At the risk of generalization, psychologists such as Richard Nisbett, at the University of Michigan, have measured ways in which Westerners tend to see the world in terms of discrete objects, while people from mainland China and Taiwan tend to focus on relationships. A typical experiment: when Americans are asked to group together two out of three things—a cow, a chicken, and a patch of grass—they are more likely to say that the cow and the chicken belong together, because they are both animals, but Asians tend to put the cow and the grass together, because the cow eats the grass. In practice, Saporta said, a Chinese patient might express a desire more indirectly than a Westerner, out of a concern for how that desire might disrupt relationships: “In psychoanalysis, you would see this person as conflicted about what they want, and you’d try to get them to be freer and more direct.” He added, “It’s not clear to me how important these differences are for therapy. Some people think they’re important and some don’t. But I think they should at least be considered.”

Snyder believes that Saporta overstates the obstacles that culture presents. “I think that the Western analysts who worry about the analyzability of the Chinese are held in the thrall of fantasies of ‘the inscrutable Oriental,’ ” she wrote recently. She is equally wary of patients who invoke Confucian explanations for their behavior or argue, as she puts it, that “you cannot analyze me because you do not understand my culture.” “When patients invoke Confucian values as the source of their anxiety and guilt, analysts are familiar with such defensive maneuvers and look more closely at the relationship with the actual parents,” she wrote. Snyder told me that the emerging rifts among foreign analysts in China are akin to “priests in the Middle Ages fighting about how many angels can dance on the head of a pin.”

Those tensions obscure a more fundamental question: should the Chinese even bother with a therapeutic approach that the West has so vigorously discarded? When I asked Frederick Crews, a retired Berkeley professor and Freud critic, about psychoanalysts touching down in China, he said, “We have had a bad habit of dumping disapproved or dangerous materials—cigarettes, chlorofluorocarbons, toxic components of old computers—on less developed countries, without regard for the consequences. Will this be another instance, in the realm of psychological treatment?”

China’s urgent need for mental-health treatment should not be invoked as a reason to promote psychoanalysis, he said. “Troubled people in China are entitled to get the best Western knowledge about their conditions. Then they can decide whether to adopt, adapt, or discard what they’ve been told.” Crews cited America’s “poisonous recovered-memory movement,” and said China holds the “worrisome potentiality for a new recovered-memory movement on a vastly larger scale.” The Chinese, he added, might do well to recall Freud’s purported comment to Jung on the way into New York Harbor, in 1909: “They don’t realize that we are bringing them the plague.”

To capture contemporary China’s specific combination of stresses, the analyst Huo Datong separates problems into two categories: jiating xiaoshi, or household issues—the private dynamics of couples and families—and guojia dashi, national issues, the things, as Huo puts it, that “are handled by the ruling Party on a national level and which people are never supposed to express doubts about: politics, freedom of speech, the right to demonstrate, and religion.”

However, the more time I spent among China’s new therapists and patients, the more these two realms seemed to be indistinguishable. In Chengdu one afternoon, I spent time with Zhang Jingyan, a fifty-six-year-old retired art-history professor who is in analysis and is studying psychotherapy. She spoke in a small voice. We were sitting on a concrete bench in the leafy yard of a temple, and she brought up the Cultural Revolution. She was twelve at the time, and Chengdu was the site of brutal street fights between factions of Red Guards. “I went to watch, and it was terrifying. I watched people being thrown off buildings,” she said. “I couldn’t move or run away. I was completely frozen by it. And then I felt ashamed: Why don’t I have more class consciousness? These are the enemies of our class! How come other people are capable of hitting them, and I’m not?”

Zhang’s father was a senior Party scholar at Sichuan University, and his stature made him a target for persecution. He was beaten, humiliated, and assigned to hard labor; he had cirrhosis, but his political status made it impossible for him to get decent care, and he died at forty. Zhang built an academic career and a family, but, over time, she became haunted by a sense of loss: “What do I want in this society? Where do I fit in? Where is my place? These are the things that have always bothered me. It didn’t affect my work, but, spiritually, I always felt that I was lacking something.”

Zhang has come to see a symmetry in China’s lurch from political mania to capitalism at all costs. “We had a mission—to liberate the world!—and then, all of a sudden, that bubble burst, and none of it was true. So what were we to do now? That’s when we started making money, and now we cling to our money. But it can’t bring us spiritual satisfaction.” As Zhang sees it, that’s the modern Chinese predicament. For all that separates her experience from that of a factory worker on an assembly line in Shenzhen, she empathizes with the factory worker. “We all need to know the value of our own existence,” she said. “If they don’t see the value of their existence, then they won’t see the meaning of living.”

Spending time among China’s aspiring analysts often put me in mind of Uncle Gustav’s attempts to unravel the mystery of authoritarianism. But, when I pulled “Dictators and Disciples” off the shelf recently, it resonated only faintly with the dictatorship that I call home. Perhaps that’s because China is a dictatorship without a dictator, having abandoned totalitarianism in favor of something far more difficult to define: a one-party state run by a committee of studiously bland apparatchiks, terrified of political challengers and convinced that its reign rests on continuing to raise the living standards of the people. Today’s Chinese disciples seem far too knowing and interconnected to have much in common with their predecessors under the Cultural Revolution, and yet the memory of their society’s dark potential still throbs like a phantom limb. Above all, our expectations of Freud have changed: Gustav wrote his book in the hope of “preventing and curing” the sources of man’s cruelty, but outside my front door the mystery endures.

Psychoanalysis may give the Chinese a vocabulary for discussing the effects of the Cultural Revolution, or the true costs of a frantic sprint to prosperity, or the toll of life under authoritarianism, but I find it hard to picture the latest Freud Fever lasting long here. Three or four years on the couch is an eternity in China, and an absurd mismatch for the life of an iPhone assembly-line worker. China is more likely to absorb the most practical of Freud’s ideas and discard the rest, as it has with Marxism, capitalism, and other imports. With luck, it might leave behind more than a few people inclined to demand respect for the value and idiosyncrasy of individual minds. ♦